Annals of Surgical Oncology

, Volume 24, Issue 2, pp 478–485 | Cite as

Effects of Neoadjuvant Laparoscopic Hyperthermic Intraperitoneal Chemotherapy and Neoadjuvant Intraperitoneal/Systemic Chemotherapy on Peritoneal Metastases from Gastric Cancer

  • Yutaka YonemuraEmail author
  • Haruaki Ishibashi
  • Masamitu Hirano
  • Akiyoshi Mizumoto
  • Kazuyosi Takeshita
  • Kousuke Noguchi
  • Nobuyuki Takao
  • Masumi Ichinose
  • Yang Liu
  • Yan Li
Gastrointestinal Oncology



The Peritoneal Cancer Index (PCI) is the most important prognostic factor following comprehensive treatment for peritoneal metastasis (PM) from gastric cancer (GCPM); however, 70 % of patients with GCPM showed a PCI score above the cut-off level at the time of diagnosis. Furthermore, neoadjuvant chemotherapy may reduce the PCI score to lower than the cut-off levels. In this study, the effects of neoadjuvant laparoscopic hyperthermic intraperitoneal chemoperfusion (NLHIPEC) and neoadjuvant intraperitoneal/systemic chemotherapy (NIPS) were investigated.

Materials and Methods

In group A, NLHIPEC was performed twice in 53 patients with GCPM, separated by a 1-month rest interval. Changes in the PCI were studied at the time of first and second laparoscopy. In group B, after NLHIPEC, a series of 3-week cycles of NIPS were performed over three courses in 52 patients. A laparotomy for cytoreductive surgery (CRS) was then carried out and the PCI changes were studied.


In group A, the PCI score at the time of the second session (11.8 ± 11.0) was significantly lower than at the time of the first session (14.2 ± 10.7), while in group B, the PCI at the time of laparotomy (9.9 ± 11.3) was significantly lower than at the time of NLHIPEC (14.8 ± 11.4). After NLHIPEC plus NIPS, complete cytoreduction was achieved in 30 (57.6 %) patients.


NLHIPEC and NIPS are effective methods of reducing PCI levels before CRS.


Gastric Cancer Docetaxel Peritoneal Metastasis Peritoneal Cancer Index Complete Cytoreduction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Conflicts of Interest

Yutaka Yonemura, Haruaki Ishibashi, Masamitu Hirano, Akiyoshi Mizumoto, Kazuyosi Takeshita, Kousuke Noguchi, Nobuyuki Takao, Masumi Ichinose, Yang Liu, and Yan Li declare that there were no potential conflicts of interest.

Supplementary material

10434_2016_5487_MOESM1_ESM.eps (603 kb)
Fig. 1 Treatment schedule of NLHIPEC and NIPS. PCI count, cytological status, and ascites volume at NLHIPEC were compared with those at laparotomy. * i.p. docetaxel + CDDP: i.p. administration of docetaxel (30 mg/m2) and CDDP (30 mg/m2) with 500 ml of saline; # i.v. docetaxel + CDDP: i.v. administration of docetaxel (30 mg/m2) and CDDP (30 mg/m2). NLHIPEC neoadjuvant laparoscopic hyperthermic intraperitoneal chemoperfusion, NIPS neoadjuvant intraperitoneal/systemic chemotherapy, PCI Peritoneal Cancer Index, i.p. intraperitoneal, i.v. intravenous, CDDP cisplatin (EPS 603 kb)
10434_2016_5487_MOESM2_ESM.eps (461 kb)
Fig. 2 Survival curves of patients who received NLHIPEC plus NIPS. Patients with a PCI score ≤11 (N = 35) at the time of CRS survived significantly longer than those with a PCI score ≥12 (N = 17) [Chi-square 5.93; p = 0.015]. NLHIPEC neoadjuvant laparoscopic hyperthermic intraperitoneal chemoperfusion, NIPS neoadjuvant intraperitoneal/systemic chemotherapy, PCI Peritoneal Cancer Index, CRS cytoreductive surgery (EPS 460 kb)
10434_2016_5487_MOESM3_ESM.docx (11 kb)
Supplementary material 3 (DOCX 11 kb)


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Copyright information

© Society of Surgical Oncology 2016

Authors and Affiliations

  • Yutaka Yonemura
    • 1
    • 2
    • 3
    • 4
    Email author
  • Haruaki Ishibashi
    • 3
  • Masamitu Hirano
    • 4
  • Akiyoshi Mizumoto
    • 4
  • Kazuyosi Takeshita
    • 3
  • Kousuke Noguchi
    • 4
  • Nobuyuki Takao
    • 4
  • Masumi Ichinose
    • 4
  • Yang Liu
    • 1
    • 3
  • Yan Li
    • 5
  1. 1.NPO Organization to Support Peritoneal Surface Malignancy TreatmentOsakaJapan
  2. 2.Department of Regional Cancer Therapies, Surface Malignancy CenterKishiwada Tokushukai Hospital, Kusatsu General HospitalKishiwadaJapan
  3. 3.Peritoneal Surface Malignancy CenterKishiwada Tokushukai HospitalKishiwadaJapan
  4. 4.Peritoneal Dissemination CenterKusatsu General HospitalKusatsuJapan
  5. 5.Department of Peritoneal Surface OncologyBeijing Shijitan Hospital of Capital Medical UniversityBeijingChina

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